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Parental Obesity and Early Childhood Development Edwina H Parental Obesity and Early Childhood Development Edwina H. Yeung, PhD, a Rajeshwari Sundaram, PhD,b Akhgar Ghassabian, MD, PhD, a Yunlong Xie, PhD, c Germaine Buck Louis, PhD, MSd BACKGROUND: Previous studies identified associations between maternal obesity and abstract childhood neurodevelopment, but few examined paternal obesity despite potentially distinct genetic/epigenetic effects related to developmental programming. METHODS: Upstate KIDS (2008–2010) recruited mothers from New York State (excluding New York City) at ∼4 months postpartum. Parents completed the Ages and Stages Questionnaire (ASQ) when their children were 4, 8, 12, 18, 24, 30, and 36 months of age corrected for gestation. The ASQ is validated to screen for delays in 5 developmental domains (ie, fine motor, gross motor, communication, personal-social functioning, and problem-solving ability). Analyses included 3759 singletons and 1062 nonrelated twins with ≥1 ASQs returned. Adjusted odds ratios (aORs) and 95% confidence intervals were estimated by using generalized linear mixed models accounting for maternal covariates (ie, age, race, education, insurance, marital status, parity, and pregnancy smoking). RESULTS: Compared with normal/underweight mothers (BMI <25), children of obese mothers (26% with BMI ≥30) had increased odds of failing the fine motor domain (aOR 1.67; confidence interval 1.12–2.47). The association remained after additional adjustment for paternal BMI (1.67; 1.11–2.52). Paternal obesity (29%) was associated with increased risk of failing the personal-social domain (1.75; 1.13–2.71), albeit attenuated after adjustment for maternal obesity (aOR 1.71; 1.08–2.70). Children whose parents both had BMI ≥35 were likely to additionally fail the problem-solving domain (2.93; 1.09–7.85). CONCLUSIONS: Findings suggest that maternal and paternal obesity are each associated with specific delays in early childhood development, emphasizing the importance of family information when screening child development. NIH a Epidemiology Branch, bBiostatistics and Bioinformatics Branch, cGlotech, Inc, and dOffi ce of the Director, WHAT’S KNOWN ON THIS SUBJECT: A high Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and proportion (20%–30%) of adults is obese. Studies Human Development, Rockville, Maryland have observed associations between maternal Dr Yeung conceptualized the analysis, supervised the data collection, performed data analysis, obesity and childhood development with increased and drafted the initial manuscript; Drs Xie and Sundaram performed statistical analysis; Dr risks of diagnosed disorders, such as autism, but Ghassabian interpreted the data; Dr Buck Louis designed the study, interpreted the data, and few accounted for paternal BMI despite epigenetic obtained funding; and all authors critically reviewed the manuscript and approved the fi nal modifi cations associated with obesity. manuscript as submitted. WHAT THIS STUDY ADDS: In this fi rst US study to DOI: 10.1542/peds.2016-1459 prospectively examine both maternal and paternal Accepted for publication Nov 3, 2016 obesity, maternal obesity was associated with delays Address correspondence to Edwina Yeung, PhD, Epidemiology Branch, Division of Intramural in fi ne motor development, whereas paternal obesity Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human was associated with delays in personal-social Development, 6710B Rockledge Dr, Rm 3122, MSC 7004, Bethesda, MD 20817. E-mail: yeungedw@ functioning, suggesting independent associations. mail.nih.gov PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). To cite: Yeung EH, Sundaram R, Ghassabian A, et al. Parental Copyright © 2017 by the American Academy of Pediatrics Obesity and Early Childhood Development. Pediatrics. 2017;139(2):e20161459 Downloaded from www.aappublications.org/news by guest on October 2, 2021 PEDIATRICS Volume 139 , number 2 , February 2017 :e 20161459 ARTICLE Approximately 1 in 5 pregnant development up to 3 years of age. completed the ASQ at 4 to 6, 8, 12, women in the United States We accounted for sociodemographic 18, 24, 30, and 36 months of age, enter into pregnancy with a BMI and lifestyle factors and examined corrected for gestational age. 30, 31 ≥30. 1 Concerns have risen that associations with GWG. We We implemented the ASQ second prepregnancy obesity may be hypothesized that both maternal and edition31 at ages 4 to 12 months and adversely associated with childhood paternal obesity would be associated the third edition30 from 18 months neurodevelopment. 2, 3 Potential with delays in early childhood onward. Each questionnaire item mechanisms include exposure development. was scored. Failing scores were to inflammation during prenatal defined as scores 2 SDs below the brain development, adipokine mean for the child’s age per ASQ dysregulation, micronutrient METHODS instructions. 30, 31 Parents were insufficiency, hyperglycemia, and contacted to administer a follow-up Study Design and Population abnormal development of the screen for any failed domain(s) by serotonin system. 2, 4 The Upstate KIDS Study recruited using an age-appropriate ASQ as 5034 women ∼4 months after 29 Evidence regarding the role of recommended by the instrument. a delivery in New York State maternal obesity on childhood The child was considered to have (excluding New York City) between neurodevelopment was recently failed the domain only if she or he 2008 and 2010. The cohort was reviewed. 2, 3 Most longitudinal also failed the follow-up screen or originally established to investigate cohorts observed negative if the parent was not reachable. the association between couples’ associations between maternal Screening instruments were fecundity and early childhood growth obesity or increased prepregnancy considered valid only if completed and development. 26 Thus, infants 30,31 BMI and childhood development in the specified age windows. A conceived by infertility treatment despite variations in the outcomes total of 3759 singletons and 1062 and multiples were oversampled. 26 studied and a wide age range of nonrelated twins with ASQ data who The primary cohort consists of ≥ assessment. 5 – 14 A few studies returned for 1 time point were all singletons and 1 randomly n showed inconsistent evidence. 15 –17 included in the analyses ( = 168, selected twin of each pair. Triplets Related studies have also examined 3% excluded). and quadruplets (n = 134 from 45 gestational weight gain (GWG) with mothers) were excluded due to low inconsistent findings. 9, 18 – 20 Parental Obesity and GWG numbers and a lack of established Although maternal obesity has guidance on appropriate GWG for At enrollment, mothers completed been the primary focus of mothers in this group. 27 The New a questionnaire about health status research, 5 – 13 evolving evidence York State Department of Health and lifestyle. Questions included suggests a possible role for paternal and the University at Albany (State information regarding both parents’ obesity.19, 21 In particular, de novo University of New York) Institutional height and weight, maternal weight mutations and potential shifts in Review Boards approved the before pregnancy, and total GWG. epigenetic programming in sperm study, and entered into a reliance Maternal prepregnancy weight, and in placenta increase with agreement with the National weight at delivery, and height also paternal BMI. 22 – 24 Paternal BMI Institutes of Health. Parents provided were extracted from electronic birth is also important to explore, as it written informed consent. certificates. Prepregnancy weight could demonstrate specificity of and height were used to calculate associations. Associations similar to Developmental Assessment prepregnancy BMI. Birth certificate information for maternal BMI was maternal BMI may suggest residual Development was measured prioritized and augmented with confounding from socioeconomic or by using the Ages and Stages 25 maternal self-reported information shared postnatal influences. On the Questionnaire (ASQ), which is a where missing (1.6%). Paternal other hand, dissimilar associations validated screening instrument BMI was calculated from weight can support true intrauterine for identifying developmental and height as reported by mothers. programming specific to maternal delays. 28, 29 The ASQ encourages BMI categories were based on BMI. parents to perform activities World Health Organization cutoffs Given few studies of childhood with their children and then (as specified in Table 1) except 148 neurodevelopment had paternal BMI respond to questions capturing 5 underweight mothers were grouped information, 12, 13, 15, 19 and none being developmental domains (ie, fine with normal weight. from the United States, our objective motor, gross motor, communication, was to evaluate associations between personal-social functioning, and GWG was calculated as the delivery parental obesity and early childhood problem-solving ability). Parents weight minus prepregnancy weight Downloaded from www.aappublications.org/news by guest on October 2, 2021 2 YEUNG et al TABLE 1 Baseline Characteristics by Maternal Prepregnancy BMI Status in Upstate KIDS (Primary Cohort) All Normal Weight, BMI Overweight, BMI Obese Class I, BMI Obese Class II/III, BMI <25.0 25.0–29.9 30.0–34.9 ≥35.0 n (%) 4821 2317 (48) 1234 (26) 639 (13) 631 (13) Maternal characteristics Prepregnancy BMI 27.06 (6.83) 21.85 (1.97) 27.21 (1.40) 32.26 (1.43) 40.62
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